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目的探讨血糖水平对血清Cystatin C浓度的影响,从而了解血糖水平在糖尿病肾病发病中的作用及其机理。方法选取57例2型糖尿病患者,入院后测量其体重指数(BMI)、空腹及餐后2 h血糖、Cystatin C、血脂及24 h尿白蛋白。治疗后当空腹血糖(FBG)≤7．0 mmol／L及餐后2 h 血糖(PBG)≤10 mmol/L时,再复查Cystatin C。并根据尿白蛋白程度分为非临床糖尿病肾病(DN)组 (24 h尿白蛋白≤300 mg)及临床DN组(24 h尿白蛋白>300 mg),临床DN组再根据疗效分为Ⅰ组及Ⅱ组,Ⅰ组为血糖控制后Cystatin C恢复正常,Ⅱ组为血糖控制后Cystatin C仍偏低。结果 (1) 治疗后无论非临床DN组还是临床DN组血Cystatin C的水平都有明显的恢复。(2)临床DN组总胆固醇、低密度脂蛋白胆固醇对疗效有明显的影响,而病程、BNI、甘油三酯、高密度脂蛋白胆固醇对疗效没有影响。结论控制血糖可以纠正DN早期高肾小球滤过率,其是可逆的。
Objective To investigate the effect of blood glucose on serum Cystatin C concentration in order to understand the role and mechanism of blood glucose in the pathogenesis of diabetic nephropathy. Methods Fifty - seven patients with type 2 diabetes mellitus (T2DM) were selected and their body mass index (BMI), fasting and postprandial 2 - hour blood glucose, Cystatin C, lipids and 24 - hour urinary albumin were measured after admission. Cystatin C was reexamined after fasting blood glucose (FBG) ≤ 7.0 mmol / L and postprandial 2 h blood glucose (PBG) ≤ 10 mmol / L. According to the level of urinary albumin, patients in non-clinical diabetic nephropathy (DN) group (24 h urinary albumin ≤ 300 mg) and clinical DN group (24 h urine albumin> 300 mg) were divided into clinical DN group In group Ⅱ and group Ⅱ, serum Cystatin C returned to normal in group Ⅰ, while in group Ⅱ, serum Cystatin C remained low after glycemic control. Results (1) The levels of serum Cystatin C in non-clinical DN group and clinical DN group were significantly recovered after treatment. (2) Clinical DN group total cholesterol, low density lipoprotein cholesterol have a significant effect on the efficacy, and duration, BNI, triglycerides, high-density lipoprotein cholesterol has no effect on the efficacy. Conclusion Control of blood glucose can correct the early high glomerular filtration rate of DN, which is reversible.